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Smartphone as Doctor

Some think that little computer you carry around with you is about to bring a sea change in the doctor-patient relationship. Is data power?

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health apps medicine

Just one of 13,000 mobile health apps out there. Photo courtesy of iHealth

If there’s any doubt that mobile apps are taking health care in directions unimaginable a few years ago, consider a few tidbits from just the past few weeks.

First, the Food and Drug Administration (FDA) just gave the green light to something called an “ingestible sensor.” It’s a tiny computer chip embedded inside a pill. You swallow that pill when you take your other meds and the ingested chip goes to work, recording when the dose went down and transmitting that data to a stick-on patch on your body. The patch then sends it to your smartphone. And to your doctor’s office, if you wish.

A few days later, yet another mobile health startup jumped into the market, this one called Mango Health, in San Francisco. Nothing so unusual about that, except the people running the small company come from a mobile games background and they’ve made it clear that they’ll be looking for ways to bring social gaming principles into the health business.

The first app they plan to roll out will be designed to help people stay on schedule with taking their meds, but also will let them know about potential interactions with other drugs and food. In the the spirit of gaming, it will reward, with discounts, those who stick to their schedules.

Game on.

Your smartphone will see you now

Hard to believe, but there are more than 13,000 different mobile health apps available for download. Most are designed to help people stick to diets or exercise routines, and, in truth, they range widely in quality and commitment to real science. Which probably explains why, according to research by the Pew Internet and American Life Project, only 10 percent of Americans with smartphones have downloaded a health app.

Expect that, though, to change dramatically over the rest of this decade as the population ages and developers focus more on helping people with serious health problems. Already, there’s been a rise in the type of apps that work with other devices to monitor your blood sugar or your blood pressure or how you slept last night.

But research suggests that data alone do not a great app make. A study published in the Journal of the American Medical Association not long ago found that apps that provide coaching tips and small financial incentives could be truly effective in getting people to change behavior, in this case, to eat a lot more fruit and be a lot less sedentary.

Boosters like to say that as they become more and more personalized, mobile apps will become the ATMs of health care, and that they’ll transform our relationship with doctors. Visits to their offices will be less frequent, but they’ll actually know more about how we’re doing thanks to what our smartphones are telling them.

Some, such as cardiolgist and author Eric Topol, go so far as to suggest that in terms of disrupting social hierarchy, this will rank right up there with Gutenberg inventing the printing press. Here’s a snippet from a recent interview on NPR’s “Science Friday”:

When individuals have access to their relevant data, sure there’s opportunities and concerns regarding it being used in a negative or promiscuous way, but when it’s used appropriately, that individual has new insight. And just like in the Middle Ages learning how to read, this is about consumers, the public, the individual having new insights and now a parity and getting out of this era of information asymmetry, where the doctors had the domain of the information.

Trust, but verify

What makes doctors skittish about the health apps boom is that the science still lags behind the market, that a lot of what’s out there has never been vetted by health professionals. But that’s changing, too. For instance, researchers at Johns Hopkins University in Baltimore have taken on the challenge of evaluating health apps, with the purpose of determining which ones can help doctors, health workers and patients at least as much as the methods they’ve always followed.

If apps are going to be the future of medicine, it’s time to get serious about making sure they can do what they say they can do. Says Dr. Alain Labrique, who’s heading up the Johns Hopkins project: “A lot of the apps you see out now have a disclaimer, or should have a disclaimer, that they have not been validated through rigorous research. It comes down to the individuals’ perceptions that the app works for them.”

Like I said, game on.

The smart in smartphones

Here’s a sampling of what health apps can do:

  • Good for what ails you: Created by two Denver ER doctors, but purchased last year by Aetna, the insurance giant, iTriage not only helps you evaluate symptoms that are making your nervous, but also suggests the best, closest hospital.
  • Doctors in the house: ZocDoc has been around a little while, but has taken off as a business. Now covering 20 American cities, it helps you find doctors in your health plan and lets you make appointments online.
  • Every cake you bake, I’ll be watching you: The iBGStar Diabetes Manager includes a $75 iPhone-enabled meter and a free app that tracks your blood glucose and insulin levels and shares that info with your doctor’s office.
  • My heart belongs to data: Sure, you can buy a blood pressure cuff and meter at any drug store, but the iHealth Blood Pressure Dock both measures your blood pressure and heart rate and produces interactive graphs of your vitals.
  • Can you hear me now?: It’s not on the market yet, but a San Francisco startup named CellScope is developing a device that attaches to a smartphone and takes photos of the inside of your son’s or daughter’s ear. It then will transmit the images to CellScope, where a physician will determine if your kid has an ear infection.
  • Run for the money: You only respond to cash motivations? An app called GymPact allows you to make a little cash if you go to the gym as often as you said you would. But you lose money–it’s charged to your credit card–if you don’t show up to work out–the GPS on your smartphone tracks if you’ve checked in.
  • If zombies can catch you, you are out of shape: This was probably inevitable, an app that motivates you to run through the fear of zombies. Zombies, Run is an audio game that you listen to when you’re on your run. But it’s not just any game. Zombies are chasing you. You can hear them breathing and groaning in your headphones. You can even mix in music from your personal playlist. Are these great times or what?

Video bonus: Big thinker Eric Topol lays out his take on the wireless future of medicine in this recent TED talk.

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